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General NPI Number Information
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NPI Number | 1043788672
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Entity Type | Individual
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Provider Name | ALLISON RENE MITCHELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 1495 CHAIN BRIDGE RD STE 300
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City | MC LEAN
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State | VA
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Zip | 22101-5727
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Country | US
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Telephone | 703-589-5559
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Fax |
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Provider Business Mailing Address
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Address Line | 4122 TETON PL
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1124
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Country | US
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Telephone | 619-788-3459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904010800
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License Number State | VA
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